I agree, pts with high Gleason Grade who are non-secretors do have poor prognosis. Its difficult to opine on their most optimum management, as there is no true indicator of response to treatment in these subgroup of pts other than evidence of clinical + / 1 radiological progression of their cancers.
If they have localised Disease as per MRI and if young —-> Offer Radical RT as opposed to surgery in view of high likelihood of disease outside the prostate. (very difficult to know about non-secretor status as we would usually assume early on that the PSA is low )
If metatsatic —> just manage them with usual std practice of Hormones with frequent use of ct scans and Bone scans to determine progression on 6 monthly or annual basis.
If hormone refractory offer them systemic chemotherapy when appropriate.
We find such pts roughly ~ 2% in our practice and we find them to be relatively young < 65, who do poorly overall.
